Provider Demographics
NPI:1609165117
Name:THOMPSON, EMILY MARIE (RN)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MARIE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:759 260TH AVE
Mailing Address - Street 2:
Mailing Address - City:AVOCA
Mailing Address - State:MN
Mailing Address - Zip Code:56114-1066
Mailing Address - Country:US
Mailing Address - Phone:507-360-4366
Mailing Address - Fax:
Practice Address - Street 1:759 260TH AVE
Practice Address - Street 2:
Practice Address - City:AVOCA
Practice Address - State:MN
Practice Address - Zip Code:56114-1066
Practice Address - Country:US
Practice Address - Phone:507-360-4366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1618433163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse